Sobrevida de la disfunción sistólica severa del ventrículo izquierdo con la terapia farmacológica actual / Survival of patients with severe left ventricular systolic dysfunction under current medication

Antecedentes: La disfunción sistólica severa del ventrículo izquierdo, con su secuela de insuficiencia cardiaca(IC) ha aumentado en las dos últimas décadas, pero su mortalidad ha disminuido con la introducción delos inhibidores de la enzima convertidora y beta-bloqueadores de tercera generación. Objetivo: Evaluar la sobrevida de un grupo de pacientes con IC desde su primera crisis Métodos: Seguimiento de una cohorte de 24 pacientes con IC de diversas etiologías (hipertensiva, alcohólica e idiopática), pero con predominio de arterioesclerosis coronaria (16 pac) durante 11 años. Los pacientes fueron tratados con terapia asociada de enalapril y carvedilol en dosis bajas, además del tratamiento clásico de la IC. Resultados: La mortalidad global fue de 8 pac (33 por ciento) y, expresada en años de seguimiento, fue de 1.8 pac/año. Las crisis de descompensación alcanzaron el 54 por ciento y las hospitalizaciones el 46 por ciento. Conclusiones: En nuestra experiencia, el tratamiento con inhibidores de la enzima convertidora y beta-bloqueadores de tercera generación, asociados a la terapia clásica de la IC, permitió una sobrevida satisfactoria a largo plazo.

Background: Severe left ventricular systolic dysfunction leading to congestive heart failure (CHF) has become more prevalent in the last decades, but mortality from this condition has decreased following the introduction of convertingenzymeinhibitors (ACE) and third generation beta blockers. Aim: To evaluate survival in a group of patients with CHF Methods: Twenty-four patients with congestive heart failure secondary to coronary artery disease (n=16), hypertension, alcoholic or idiopathic cardiomyopathy were followed during 11 years. Patients were treated with combined therapy of enalapril and low dose carvedilol, along with other conventional drugs. Results: Eight patients died during follow up (33 percent or 1.8 patients per year). Decompensation of heart failure occurred in 54 percent and rehospitalization in 46 percent of patients. Conclusion: Treatment with an ACE inhibitor and a third generation beta blocker along with conventional drugs was associated to a satisfactory long term survival in patients with CHF.

Endocarditis infecciosa: factores pronósticos de mortalidad en 131 casos / Infectious endocarditis: prognostic factors of mortality in 131 cases

We followed during their hospital stay, 129 patients aged 14 to 74 years old, who had 131 episodes of infective endocarditis. Clinical assessment, echocardiography and microbiological study was done to all patients. Surgical indications were those derived from complications. Thirty three patients died during hospital stay (25.2 percent). There were no differences between survivors and deceased patients in the lapse between onset of symptoms and hospital admission, presence of fever, dyspnea or heart murmurs. Skin and mucosal septic manifestations occured with higher frequency in deceased patients (57.1 and 24.3 percent respectively). Blood cultures were positive in 55 percent in survivors and 48 percent in those who died. The most frequent infecting organisms were staphilococci and streptococci. Vegetations were found with greater frequency in aortic position in both groups of patients. Deceased patients had a higher frequency of cardiac failure (84 and 65 percent respectively) and embolic episodes (77 and 46 percent respectively) than survivors. Antimicrobial treatment was successfull in 94 percent of survivors and 15 percent of those who died. Forty percent of survivors and 54 percent of deceased patients were subjected to surgical procedures. The most important predictor of hospital mortality in this series of patients with infective endocarditis was antimicrobial treatment failure